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1Department of Health Policy and Management, Center for Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA

jkim{at}hsph.harvard.edu

Subsequent disease is reduced in women who undergo treatment post-vaccination

The two most carcinogenic types of human papillomavirus (HPV) types 16 and 18, are responsible for around 70% of cervical cancers, 85% of anal cancers, and a smaller proportion of other anogenital and oral cancers.1 Vaccines that target these two sexually transmitted HPV types have consistently shown high efficacy in preventing disease related to those specific HPV types in people who have not yet been exposed.23456 In the linked study (doi:10.1136/bmj.e1401), which is a post hoc analysis of the main efficacy trials (FUTURE I and FUTURE II) of the quadrivalent HPV vaccine that also targets non-carcinogenic HPV types 6 and 11 (responsible for most genital warts),23 Joura and colleagues show a reduction in subsequent HPV related disease in vaccinated women who received treatment for cervical, vulvar, or vaginal disease (including genital warts) during the course of the trial.7 This protection extended to disease associated with not only the four HPV types targeted by the vaccine but also 10 other HPV types that cause cancer.

The study’s findings—including reductions in any HPV related disease (irrespective of causal HPV type) of 46.2% after cervical surgery and 35.2% after diagnosis of vulvar or vaginal disease—are welcome, but some important caveats …